A sobbing man shepherded by two women made slow, deliberate progress away from the transit center’s glow and toward the back of a white van.
A Breathalyzer test taken minutes earlier, around 8:30 p.m., put the man’s blood-alcohol content at 0.413. He was guided with reassuring voices by Dawn Voss and Michel Barte, emergency medical technicians for Community Assistance Response and Emergency Services.
The program, colloquially called sleep off, offers transport and a place to sleep to chronically inebriated people, and the Empire was able to see it in action during a ride-along.
The women successfully talked the emotional, drunk man to willingly accept a ride to Bartlett Regional Hospital where he could be screened before potentially making his way to the CARES’ sobering center in the Mendenhall Valley to sleep off his condition. A BAC over 0.40 triggers a precautionary trip to the emergency room, Barte said.
[CCFR set to take over sleep-off program]
“It’s all right,” Voss said gently while walking the man. “We all have bad days. We just want you to be safe.”
The man apologized, and Voss assured him it was OK while guiding him into the van where he joined three other drunk men.
“This is what we do,” Voss said.
Joe Mishler, CARES program manager, said CARES staff are encouraged to treat the people they help well because freeing up police and ambulance services for the rest of the community is a central goal of the program. A kind tone helps accomplish that.
“We want them to want to come with us,” Mishler said.
If a person declines to go with CARES, attempts to just “walk it off” and passes out in public, they could wind up taking a trip to the hospital via ambulance.
Mishler said that draws resources away from people who might be suffering from a stroke, heart attack or injury.
“ You’re occupying an ambulance, you’re occupying emergency room staff, you’re occupying an emergency room bed for people who don’t have an emergency,” Mishler said. “We’re serving the community by doing this.”
The Community Assistance Response and Emergency Services van stops at the emergency room at Bartlett Regional Hospital Wednesday, Dec. 11, 2019. If a chronically inebriated person has a blood-alcohol content greater than .4, CARES takes them to the hospital to make sure they are well enough to spend the night in the sleep-off program. (Ben Hohenstatt | Juneau Empire)
Half the hours, not half the calls…
Through its first almost-six months of operations, CARES saw about the same level activity as the sleep-off program did when it was operated by Bartlett Regional Hospital.
The program received an average of 168 calls per month since July when Capital City Fire/Rescue began operating the sobering center in a St. Vincent de Paul’s building that formerly housed a thrift store. That tally includes transports to the sleep-off center and to other safe places.
That is close to the 180 calls the sleep-off program averaged when it operated 24/7 and was run by the hospital in the first half of the year.
The sleep-off program now generally operates 8 p.m.-8 a.m. Typically, two CARES, employees work 12-hour shifts. Some CARES staff such as Voss, previously worked for the hospital’s sleep-off program.
However, inebriated people sometimes arrive late in that window and stay at the center longer, which means longer hours for staff.
“We’ve had people come in as late as 6 in the morning, which obviously don’t leave at 8 a.m.,” Mishler said.
In those instances, Mishler said a part-time worker will man the sleep-off center.
…But that could change
While calls have stayed relatively consistent so far, the number of calls may dwindle in the coming months.
When temperatures fall below freezing, a warming shelter operated by St. Vincent de Paul that is near but separate from the sleep-off center is open, and Mishler said it tends to attract some CARES users.
Also, the second phase of Housing First, a collaborative program that offers rooms to Juneau’s most vulnerable residents, is expected to open in the first half of next year.
Mishler said that will likely reduce the number of people who spend the night at CARES’ center.
Housing First’s 32 rooms are currently full and offer housing to Juneau residents with especially high vulnerability indexes. That differs from CARES’ openness to frequent chronic inebriates without homes and first-timers who may only lack a place to stay for that night.
One reason Housing First could have a sizable impact on CARES users is that unlike the Glory Hall, it does not prohibit alcohol. At Glory Hall, patrons must have a BAC below .10.
Another reason is the impact 32 rooms can have on Juneau’s homeless population.
A 2019 CBJ homeless count put the number of homeless people in the city at 210 with 103 in transitional housing, 72 in emergency shelter and 35 unsheltered.
[Little rooms make a big difference for Juneau’s most vulnerable population]
Mishler said there is a group of about 30 regular chronic inebriates known to staff.
A new Housing First facility with rooms for 32 could change the needs of a significant portion of the population. Mishler said the first Housing First building did.
However, he said it is still common for Housing First residents to become inebriated downtown and need transportation via CARES’ van to Housing First.
Currently, the sleep-off center’s four beds are full more often than not.
Dawn Voss, emergency medical technicians for Community Assistance Response and Emergency Services, stands in the room where people who use the City and Borough of Juneau’s sleep-off program sleep, Wednesday, Dec. 11, 2019. (Ben Hphenstatt | Juneau Empire)
“We were full 57% of the nights in November, and we’ve been running right around 60% of the nights where we’re full, and a lot of times we’re full within the first hour or two,” Mishler said.
The first six months
City officials said six months into CCFR’s time at the helm of the sleep-off program, things are going smoothly.
“As far as I know the transition is going well,” Mayor Beth Weldon said.
CCFR Fire Chief Rich Etheridge and Deputy City Manager Mila Cosgrove, who oversees the fire department for the manager’s office, said the same.
Etheridge added that CARES is on target to stay within its $800,000 budget. That money comes from liquor tax collected by CBJ and was previously budgeted for the hospital.
That sum was controversial when the City and Borough of Juneau Assembly considered whether operations of the sleep-off program should be transferred from the hospital to the fire department. CBJ also provided the hospital $800,000, but the program operated 24/7 instead of 12 hours per day.
“There are a lot of people that I’ve talked to that don’t think we should be spending money on chronic inebriates,” Mishler said. “What we’re spending money on is the community as a whole to keep our emergency services available for emergency services. That’s our focus.”
Etheridge and Mishler also said there were start-up costs for the first year of the program they don’t expect to recur next year.
During the discussion of transferring sleep-off program responsibilities, a legal explanation for the program’s continued existence in lieu of taking chronic inebriates to Lemon Creek Correctional Center was also cited —Alaska Statute 47.37.170.
Under state statute, a person who appears to be intoxicated in public and in need of help may be taken into protective custody and taken home, an approved public treatment facility, private treatment facility or a health facility.
“If all of the preceding facilities, including the person’s home, are determined to be unavailable, a person taken into protective custody and assisted under this subsection may be taken to a state or municipal detention facility in the area,” states the statute.
Similarly, a person who appears incapacitated by alcohol or drugs in public should be taken into protective custody and immediately brought to an appropriate facility. If no treatment facility or emergency medical service is available, then a person can be taken to a detention facility, like LCCC, if it appears necessary for protecting the person’s health or safety, according to the statute.
Another point of contention early on has been the program’s new location in a building leased from St. Vincent de Paul.
Mishler, Voss and Barte acknowledged there is a perception that the sleep-off center is bringing crime and drug use from downtown Juneau to the Mendenhall Valley.
However, Mishler refuted that idea.
The center accommodates only four people who are monitored the entire time they are with CARES and cannot come and go from the facility, Mishler said. In the morning, the people are given a bus token and typically return downtown.
“They’re probably the only people at night in the Valley that cannot be committing crimes because they’re being video monitored while sleeping,” Mishler said.
A normal night
A recent Wednesday night was a typical one for CARES.
By 8:05 p.m., a call came in that three men needed to be picked up at the Capital City Transit Center downtown. A fourth man, who was taken to the emergency room, became part of the group when Voss and Barte arrived to talk to the men and check their BAC levels.
Mishler said calls are prioritized based on who is calling and why. A call reporting an unconscious person takes the highest priority. Next up are calls from police or emergency responders. Calls from the emergency room are the third priority. Self-calls, such as the one that came through Wednesday, are the fourth highest priority, Mishler said.
Three of the men had spent the previous night at the sleep-off center, Voss and Barte said, and the man taken to the emergency room en route to the sleep-off center was unknown to them.
While Voss, Mishler and Barte said many who use CARES are known to staff and regularly need transport or a safe place to sleep, it’s also normal to see a new face.
“There are one-and-dones,” Voss said.
[Flu activity is on the rise in Alaska]
Barte said it’s also normal to not see a regular user for a while. People sometimes find a place to stay or sober up for a while.
The men who were at the sleep-off center were all known to each other and both Voss and Barte, and interactions were friendly and civil.
In conversation, the men were evidently drunk but generally coherent despite BAC levels three to four times the legal driving limit. They complimented CARES staff.
“They’re good people — top-notch,” said one of the men.
When asked what they’d do if the program did not exist, one man said he’d likely die in the streets. Another said he’d sleep in the streets.
While the men were being processed, a call came in for another regular user of the program. Voss went to pick up the man while Barte saw to the three men at the center.
Once vital signs — blood pressure, pulse and respiration — indicated the men weren’t in immediate danger, those who wanted Cup Noodles or earplugs —one man was a known snorer — were given some, and they were guided to a camera-monitored room containing four mats.
Mishler said while giving CARES users soup is a nice thing to do, it’s also meant to encourage sleep, which is the center’s purpose.
Shortly after the three men went to bed, Voss soon arrived back at the center, and the fourth man had his vital signs taken.
The sleep-off center was at full capacity well before 10 p.m.
Not just sleep off
Mishler said CARES is more than just the sleep-off program, and transport is currently a big part of what CARES offers.
Once the center is at capacity, that does not mean the two people working are done responding to calls.
“If we know we don’t have beds for them, we take care of what we can on scene,” Voss said.
That means determining if someone can stay with friends or family or if they might be a Housing First resident.
Depending on someone’s level of intoxication, behavior and health, CARES might transport a person to the hospital or Lemon Creek Correctional Center for a 12-hour hold, which Voss said does not lead to criminal charges.
While those are the same places someone is likely to end up if transported by police or an ambulance, Mishler said CARES providing the transportation frees up those services.
[Downtown bar closes for business]
Mishler said CARES also coordinates with St. Vincent de Paul’s Community Navigators program, which helps people in need of food, housing, clothing and other services.
Moving forward, Mishler said he would like to see CARES operate during the day, provide paramedicine services and help another population that often makes calls to emergency services in not-quite emergencies: the elderly.
“That’s another part of the CARES program we want to implement,” Mishler said.
However, he said that likely means giving the program more time to develop and potentially more funding.
“As we have the availability, we want to branch out into community paramedicine and then start trying to hit public education as well,” Mishler said. “It’s not that we don’t spend money on folks, it’s not that we don’t take care of them, it’s just that we use the wrong services.”
By the numbers
168 CARES has averaged 168 calls per month since it began operating in July.
60 % CARES’ sleep-off center is at capacity about 60% of the time. Often, its beds are full within the first few hours of opening.
4 There are four beds available to chronic inebriates in the St. Vincent de Paul-owned building on Teal Street.
2 Typically, CARES sleep-off emergency medical technicians
• Contact reporter Ben Hohenstatt at (907)523-2243 or bhohenstatt@juneauempire.com. Follow him on Twitter at @BenHohenstatt
